Actual test done September 27, 2019 by a 70 year old female.
LAB #: #####-####-1
PATIENT: #### ####
CLIENT #: ####
DOCTOR: #### ####
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Tungsten Urine Test
pH upon receipt:
timed: 6 hours
less than detection limit
Creatinine by Jaffe Method
Results are creatinine corrected to account for urine dilution variations. Reference intervals and corresponding graphs
are representative of a healthy population under non-provoked conditions. Chelation (provocation) agents can
increase urinary excretion of metals/elements.
©DOCTOR’S DATA, INC. y
yyy ADDRESS: 3755 Illinois Avenue, St. Charles, IL 60174-2420 yyyy LAB DIR: Erlo Roth, MD yyyy CLIA ID NO: 14D0646470
This analysis of urinary elements was performed by ICP-Mass Spectroscopy following acid
digestion of the specimen. Urine element analysis is intended primarily for: diagnostic
assessment of toxic element status, monitoring detoxification therapy, and identifying or
quantifying renal wasting conditions. It is difficult and problematic to use urinary elements
analysis to assess nutritional status or adequacy for essential elements. Blood, cell, and
other elemental assimilation and retention parameters are better indicators of nutritional
1) 24 Hour Collections
”Essential and other” elements are reported as mg/24 h; mg element/urine volume (L) is
equivalent to ppm. ”Potentially Toxic Elements” are reported as µg/24 h; µg element/urine
volume (L) is equivalent to ppb.
2) Timed Samples (< 24 hour collections)
All ”Potentially Toxic Elements” are reported as µg/g creatinine; all other elements are
reported as µg/mg creatinine. Normalization per creatinine reduces the potentially
great margin of error which can be introduced by variation in the sample volume. It
should be noted, however, that creatinine excretion can vary significantly within an
individual over the course of a day.
If one intends to utilize urinary elements analysis to assess nutritional status or renal
wasting of essential elements, it is recommended that unprovoked urine samples be
collected for a complete 24 hour period. For provocation (challenge) tests for potentially
toxic elements, shorter timed collections can be utilized, based upon the
pharmacokinetics of the specific chelating agent. When using EDTA, DMPS or DMSA,
urine collections up to 12 hours are sufficient to recover greater than 90% of the
mobilized metals. Specifically, we recommend collection times of: 9 – 12 hours post
intravenous EDTA, 6 hours post intravenous or oral DMPS and, 6 hours post oral
bolus administration of DMSA. What ever collection time is selected by the physician, it
is important to maintain consistency for subsequent testing for a given patient.
If an essential element is sufficiently abnormal per urine measurement, a descriptive text
is included with the report. Because renal excretion is a minor route of excretion for
some elements, (Cu, Fe, Mn Zn), urinary excretion may not influence or reflect body
stores. Also, renal excretion for many elements reflects homeostasis and the loss of
quantities that may be at higher dietary levels than is needed temporarily. For these
reasons, descriptive texts are provided for specific elements when deviations are
clinically significant. For potentially toxic elements, a descriptive text is provided
whenever levels are measured to be higher than expected. If no descriptive texts follow
this introduction, then all essential element levels are within acceptable range and all
potentially toxic elements are within expected limits.
Reference intervals and corresponding graphs shown in this report are representative of a
healthy population under non-provoked conditions. Descriptive texts appear in this report
on the basis of measured results and correspond to non-challenge, non-provoked conditions.
Chelation (provocation) agents can increase urinary excretion of metals/elements. Provoked
1999–2019 Doctor’s Data, Inc.
reference intervals have not been established therefore non-provoked reference intervals shown
are not recommended for comparison purposes with provoked test results. Provoked results can be
compared with non-provoked results (not reference intervals) to assess body burden of metals
and to distinguish between transient exposure and net retention of metals. Provoked results can
also be compared to previous provoked results to monitor therapies implemented by the treating
physician. Additionally, Ca-EDTA provoked results can be used to calculate the EDTA/Lead
Excretion Ratio (LER) in patients with elevated blood levels.
CAUTION: Even the most sensitive instruments have some detection limit below which
a measurement cannot be made reliably. Any value below the method detection limit is
simply reported as ”< dl.” If an individual excretes an abnormally high volume of urine,
urinary components are likely to be extremely dilute. It is possible for an individual to
excrete a relatively large amount of an element per day that is so diluted by the large
urine volume that the value measured is near the dl. This cannot automatically be
assumed to be within the reference range.
The level of tungsten (W) in this urine sample is higher than expected. After exposure
and absorption via inhalation, ingestion or injection, most W is rapidly eliminated via urine
and feces. W has no known biological role. Long-term chronic exposures have been
associated with lung disease (pneumoconiosis or ”hard metal lung disease”) and lung cancer.
Skin contact with W may produce contact eczema, pruritis, folliculitis, and neurodermatitis.
Tungsten has an antagonistic relationship with molybdenum (Mo) decreasing hepatic Mo
concentration and reducing the effectiveness of sulfite and xanthine oxidases.
Tungsten is a silvery-white lustrous element usually obtained as a grey powder and is
mainly utilized as tungsten carbide in metal-working, mining and petroleum industries. Calcium
and magnesium tungstates are widely used in filaments for electric lamps, electron tubes and
television tubes. Since W has the highest melting point of all metals it is used for high-speed
and hot-worked steels. Other sources of W include catalysts and reagents in biological analysis,
fire and waterproofing materials, and industrial lubricants.
For people exposed to hard-metal dust, W levles can reach .014 µg/g in urine. Intestinal
absorption of tungsten is rapid and seemingly significant. W is rapidly transported to the blood
and then to the kidneys for filtration and eventual excretion from the body. In a rat study, elimination
of W via feces was slower than that of urine but reached 52% after three days. Pulmonary
absorption of W-tungstic oxide has been studied in dogs. 60% of W is rapidly deposited in the
respiratory tract and 33% of that fraction reaches systemic circulation. Tungsten is also easily
transferred from mother to fetus usually later in gestation.
Urinary W levels may be elevated after administration of DMPS or DMSA; comparison of urine W
before and after provocation provides an estimate of net retention of W over time.
BIBLIOGRAPHY FOR TUNGSTEN, HIGH
1. Marquet, P., Francois, B., Lotfi, H., Turcant, A., Debord, J., Nedelec, G., Lachatre, G.
1999–2019 Doctor’s Data, Inc.
Tungsten determination in biological fluids, hair and nails by plasma emission
spectrometry in a case of severe acute intoxication in man. J Forensic Sci 42(3):527-30,
2. Seiler, H., Sigel, A., Sigel, H. Handbook on Metals in Clinical and Analytical Chemistry.
New York, Marcel Dekker, Inc., 1994.
This individual’s urine uranium (U) is markedly higher than that of the general population.
Renal excretion is the primary route of U excretion. This finding is consistent with an excessive
exposure to uranium or to an unusually high body burden of this element.
Uranium is a radioactive element having 10 isotopes with half lives that exceed one hour. U238
constitutes about 99% of the naturally-occurring uranium and this is the isotope measured at DDI
and reported for this individual. U238 has a half life of 4.5 X 10 to the ninth years. It decays by
alpha emission to produce thorium, Th234, the initial step in a decay chain that eventually leads to
lead. Alpha, beta and gamma emissions occur during this decay process. Because of the very
long half life, the radioactivity danger is only slight. However, exposure to enriched or nuclear fuel
grade U (high in U235) does pose a health hazard. The measured result (U238) does not reflect or
imply exposure to enriched U235.
The major concern for (natural) uranium excess is toxochemical rather than radiochemical.
Uranium is a chemically-reactive element, has four valences (3,4,5 or 6), and may combine with:
carbonate, phosphate, citrate, pyruvate, malate, lactate, etc. in body tissues. When not excreted
in urine, it may accumulate in the kidneys, spleen, liver, and in bone (substituting for calcium in
hydroxyapatite). Uranium is nephrotoxic, causing damage to the glomeruli and proximal tubules.
An early sign of U excess is general fatigue. Renal damage is reflected by proteinuria, hyper-
aminoaciduria and glucosuria. Albuminuria and urinary catalase are findings consistent with
U excess. Elevated hair U may provide further information regarding U exposure. Whole blood
analysis may corroborate very recent or ongoing exposure. There are no currently available metal
binding/chelating agents to assess the net retention of U that may have occurRed over time.
Uranium is more common than mercury, silver or cadmium in the earth’s rock strata, and may
be present, at low levels, in ground (drinking) water. Most commercial use of U is for nuclear fuel,
but it may be present in ceramics or colored glass, especially ancient or antique, yellow-colored glass.
BIBLIOGRAPHY FOR URANIUM
1. Carson B.L. et al Toxicology and Biological Monitoring of Metals in Humans, Lewis Publishers,
Chelsea MI. pp. 272-75, 1986.
2. Handbook of Chemistry and Physics, 49th ed., CRC, Cleveland, OH, pp B-143-44, 1968.
3. Leggett R.W., ”The Behavior and Chemical Assessment of U in the Kidney: a Reassessment”,
Health Physics, 57 no.3, pp 365-83, 1989.
4. Byrne A.R. and L. Benedik, ”Uranium Content of Blood, Urine and Hair of Exposed and Non-
Exposed Persons Determined by Radiochemical Neutron Activation Analysis…” The Science of
the Total Environment, 107, pp 143-57 1991.
5. Bentley K.W. and J.H. Wyatt, ”Quantitative Determination of Fissionable materials in Human
Hair” Environ. Res. 21 pp 407-15, 1980.
1999–2019 Doctor’s Data, Inc.
1999–2019 Doctor’s Data, Inc.
Actual test done September 27, 2019 by 70 year old female.